Monitoring Digital Health Equity Across the Digital Front Door: U.S. Trends in Broadband Access, Portal Offers, and Patient IT Use in 2017-2020.

Background/

Objectives

Patient portals and patient-facing information technologies are now routine channels for healthcare delivery, but healthcare organizations need practical ways to monitor whether these channels are equitably accessible and used. This study examined U.S. national trends in digital health equity from 2017 to 2020 using three Healthy People/HINTS indicators representing an access-offer-use pathway: broadband access, being offered online access to medical records, and using information technology to track or communicate about care.

Methods

We conducted a repeated cross-sectional analysis of publicly available aggregate Healthy People 2030 indicator data based on the Health Information National Trends Survey. National trends were summarized for HC/HIT-05, HC/HIT-06, and HC/HIT-07. Education- and income-related inequalities were assessed using the Slope Index of Inequality and Relative Index of Inequality. Subgroup variation was examined using precision-adjusted funnel monitoring with overdispersion adjustment. Sensitivity analyses assessed alternative overdispersion specifications, weighting approaches, and confidence-interval diagnostics.

Results

From 2017 to 2020, broadband access declined from 55.9% to 41.5%, while portal offers increased from 61.4% to 72.0% and patient IT use increased from 80.0% to 83.3%. Socioeconomic inequalities persisted across the pathway. Education-related gradients widened for broadband access and portal offers, whereas education and income gradients narrowed for downstream patient IT use. Funnel monitoring indicated subgroup heterogeneity beyond expected sampling variation, supporting the need for equity monitoring beyond aggregate national trends.

Conclusions

Digital health performance should not be evaluated using overall uptake alone. Monitoring access, organizational offering, and patient use as separate but connected stages can help healthcare organizations, payers, and policymakers identify where inequities occur and target connectivity screening, portal-offer workflows, digital navigation support, and low-bandwidth service design.